{"id":1088,"date":"2025-10-30T20:17:18","date_gmt":"2025-10-30T20:17:18","guid":{"rendered":"https:\/\/sites.sandiego.edu\/cpil-blog\/?p=1088"},"modified":"2025-10-30T20:17:18","modified_gmt":"2025-10-30T20:17:18","slug":"medical-board-of-californias-cme-mandate-upheld-by-ninth-circuit-as-government-speech","status":"publish","type":"post","link":"https:\/\/sites.sandiego.edu\/cpil-blog\/2025\/10\/30\/medical-board-of-californias-cme-mandate-upheld-by-ninth-circuit-as-government-speech\/","title":{"rendered":"Medical Board of California\u2019s CME Mandate Upheld by Ninth Circuit as Government Speech"},"content":{"rendered":"<h3>By Jordan Gierke<\/h3>\n<p><strong><em>Khatibi, et al. v. Hawkins, et al., <\/em><\/strong><strong>Case No. 24-3108 (9th Cir.).<\/strong> On July 25, 2025, the United States Court of Appeals for the Ninth Circuit <a href=\"https:\/\/drive.google.com\/file\/d\/1k4oxUOYhCC0YBDq6b1sag8nlvoNhF06r\/view?usp=sharing\">affirmed<\/a> the dismissal of the plaintiffs\u2019 claims. In its order, the Ninth Circuit held that Continuing Medical Education (CME) courses required by California law and approved by the Medical Board of California (MBC) constitute government speech and are not subject to First Amendment free speech challenges.<\/p>\n<p>To determine whether something constitutes government speech, courts examine \u201cthe history of the expression at issue; the public&#8217;s likely perception as to who (the government or a private person) is speaking; and the extent to which the government has actively shaped or controlled the expression.\u201d <em>Id.<\/em> at 1141 (quoting <em>Shurtleff v. City of Bos.<\/em>,<em> Massachusetts<\/em>, 596 U.S. 243, 252 (2022)). First, California and the MBC have a long-established role in regulating medical education and CME requirements to \u201cprotect the public against incompetent, impaired, or negligent physicians,\u201d reflecting a clear pattern of the state communicating professional standards to doctors, supporting the conclusion that CME content constitutes government speech<em>. Id.<\/em> at 1147. Additionally, although private instructors deliver the courses, CME courses are created specifically for \u201clicensed medical professionals\u201d who understand that their \u201cprofession is heavily regulated since they must comply with myriad requirements, including various CME mandates, to maintain their licenses.\u201d <em>Id.<\/em> at 1150. Physicians typically do not take CME courses unless they are \u201celigible for credit,\u201d suggesting that licensees recognize CMEs are mandated and approved by the MBC, and that the content reflects the state\u2019s message rather than the views of the individual instructor. <em>Id.<\/em> Finally, California sets required topics and establishes standards for approving, auditing, and rejecting courses. From start to finish, California \u201cdictates, controls, and approves the provider, form, purpose, and content\u201d of CME courses, demonstrating that the State controls the content. <em>Id.<\/em> at 1141\u201342.<\/p>\n<p>On November 18, 2019, the Legislature amended sections 2190.1 and 3524.5, and added section 2736.5 to the Business and Professions Code through <a href=\"https:\/\/leginfo.legislature.ca.gov\/faces\/billTextClient.xhtml?bill_id=201920200AB241\">AB 241 (Kamlager-Dove) (Chapter 417, Statutes of 2019).<\/a> The 2019 amendment mandated that CME courses include a curriculum on understanding implicit bias, effective January 1, 2022. The Legislature required this curriculum in response to disparate treatment based on \u201crace, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics,\u201d which \u201ccontributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees.\u201d<em> Khatibi<\/em>, 145 F.4th at 1143.<\/p>\n<p>On August 1, 2023, Dr. Khatibi and the advocacy organization Do No Harm filed a <a href=\"https:\/\/drive.google.com\/file\/d\/1NP6vKGcCzI5sJNh7jTI4u_UogIHDLiYU\/view?usp=sharing\">complaint<\/a> against the MBC, challenging the CME requirement in section 2190.1(d)(1) of the Business and Professions Code, which mandates that CME courses eligible for credit toward license renewal include training on implicit bias in healthcare. [<em>see<\/em> <a href=\"https:\/\/digital.sandiego.edu\/cgi\/viewcontent.cgi?article=3225&amp;context=crlr\"><em>30:1 CRLR 20<\/em><\/a>]. The plaintiffs argued that the new implicit bias content violated their free speech rights by compelling them to express or support views with which they disagreed. On May 2, 2024, the trial court <a href=\"https:\/\/drive.google.com\/file\/d\/1_gdFq3iJ4xF74BY6CrAhiOCRLJhH7Bcz\/view?usp=sharing\">dismissed<\/a> the case, concluding that CME constitutes government speech immune from First Amendment scrutiny and that the plaintiffs\u2019 claim was not plausible. The plaintiffs appealed.<\/p>\n<p>On August 8, 2025, the petitioners <a href=\"https:\/\/drive.google.com\/file\/d\/1B2XAumpfu17v7xHaYhBOpgTYJVHV7kzy\/view?usp=sharing\">filed<\/a> a petition for a panel rehearing and a rehearing en banc of their case due to inconsistencies between the panel\u2019s decision and established First Amendment precedent, which they argue warrant further review to clarify the limits of the government speech doctrine and protect licensed professionals\u2019 free speech rights. The California Attorney General\u2019s Office,\u00a0 Defendants-Appellees, filed their <a href=\"https:\/\/drive.google.com\/file\/d\/1TuqUUBzosbj9JonNX8qvblMOOrc3QCIR\/view?usp=sharing\">response<\/a> on September 23, 2025. In its brief, the AG defends the panel\u2019s ruling as a faithful, cautious application of the Supreme Court\u2019s government-speech doctrine to a uniquely state-controlled CME system. It argues the plaintiffs\u2019 concerns about overreach are unfounded because the ruling is limited to California\u2019s specific regulatory framework and does not endanger broader professional or academic speech rights. As of this writing, the Ninth Circuit has not ruled on the petition.<\/p>\n<a class=\"synved-social-button synved-social-button-follow synved-social-size-32 synved-social-resolution-single synved-social-provider-facebook nolightbox\" data-provider=\"facebook\" target=\"_blank\" rel=\"nofollow\" title=\"Follow us on Facebook\" href=\"https:\/\/www.facebook.com\/CPILUSD\" style=\"font-size: 0px;width:32px;height:32px;margin:0;margin-bottom:5px;margin-right:5px\"><img loading=\"lazy\" decoding=\"async\" alt=\"Facebook\" title=\"Follow us on Facebook\" class=\"synved-share-image synved-social-image synved-social-image-follow\" width=\"32\" height=\"32\" style=\"display: inline;width:32px;height:32px;margin: 0;padding: 0;border: none;box-shadow: none\" src=\"https:\/\/sites.sandiego.edu\/cpil-blog\/wp-content\/plugins\/social-media-feather\/synved-social\/addons\/extra-icons\/image\/social\/circle\/64x64\/facebook.png\" \/><\/a><a class=\"synved-social-button synved-social-button-follow synved-social-size-32 synved-social-resolution-single synved-social-provider-twitter nolightbox\" data-provider=\"twitter\" target=\"_blank\" rel=\"nofollow\" title=\"Follow us on Twitter\" href=\"https:\/\/twitter.com\/cpilusd\" style=\"font-size: 0px;width:32px;height:32px;margin:0;margin-bottom:5px\"><img loading=\"lazy\" decoding=\"async\" alt=\"twitter\" title=\"Follow us on Twitter\" class=\"synved-share-image synved-social-image synved-social-image-follow\" width=\"32\" height=\"32\" style=\"display: inline;width:32px;height:32px;margin: 0;padding: 0;border: none;box-shadow: none\" src=\"https:\/\/sites.sandiego.edu\/cpil-blog\/wp-content\/plugins\/social-media-feather\/synved-social\/addons\/extra-icons\/image\/social\/circle\/64x64\/twitter.png\" \/><\/a>","protected":false},"excerpt":{"rendered":"<p>By Jordan Gierke Khatibi, et al. v. Hawkins, et al., Case No. 24-3108 (9th Cir.). On July 25, 2025, the United States Court of Appeals for the Ninth Circuit affirmed the dismissal of the plaintiffs\u2019 claims. In its order, the <a class=\"more-link\" href=\"https:\/\/sites.sandiego.edu\/cpil-blog\/2025\/10\/30\/medical-board-of-californias-cme-mandate-upheld-by-ninth-circuit-as-government-speech\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1013,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[137218,132859],"tags":[15715,138384,9922,132863,132965],"coauthors":[138175],"class_list":["post-1088","post","type-post","status-publish","format-standard","hentry","category-litigation-medical-board-of-california","category-medical-board-of-california","tag-california","tag-continuing-medical-education","tag-litigation","tag-mbc","tag-medical-board"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medical Board of California\u2019s CME Mandate Upheld by Ninth Circuit as Government Speech - Consumer Protection Policy Center - Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sites.sandiego.edu\/cpil-blog\/2025\/10\/30\/medical-board-of-californias-cme-mandate-upheld-by-ninth-circuit-as-government-speech\/\" class=\"yoast-seo-meta-tag\" \/>\n<meta property=\"og:locale\" content=\"en_US\" class=\"yoast-seo-meta-tag\" \/>\n<meta property=\"og:type\" content=\"article\" class=\"yoast-seo-meta-tag\" \/>\n<meta property=\"og:title\" content=\"Medical Board of California\u2019s CME Mandate Upheld by Ninth Circuit as Government Speech - Consumer Protection Policy Center - Blog\" class=\"yoast-seo-meta-tag\" \/>\n<meta property=\"og:description\" content=\"By Jordan Gierke Khatibi, et al. v. 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